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59]
Original Article
Airway management
using transmylohyoid
oroendotracheal(submental)
intubation in maxillofacial trauma
Department of Oral and Maxillofacial
Surgery, Faculty of Dentistry, Jamia
Millia Islamia, 1Department of Dental
Surgery, Sir Gangaram Hospital,
NewDelhi, 2Department of Anesthesia,
Sarvodaya Hospital, 3Department of
Orthopaedics, Santosh Medical College
and Hospital, Ghaziabad,
Uttar Pradesh, India
Introduction
It has been almost three decades since the submental
intubation technique was first proposed by Hernndez
Altemir[1] for managing airway in complex maxillofacial
injuries. The term transmylohyoid oroendotracheal
intubation was first coined by Gadre and Kushte,[2] they
proposed that the transmylohyoid route and the term
transmylohyoid oroendotracheal intubation is more apt
as the path of exit of endotracheal tube(ETT) is across the
mylohyoid muscle and not restricted to the submental
triangle.[3] We here retrospectively evaluate 12patients
of complex maxillofacial trauma in which this technique
was employed avoiding a tracheotomy. The advantages,
disadvantages and complications of transmylohyoid
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DOI:
10.4103/0975-5950.154815
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Khan, et al.: Transmylohyoid oroendotracheal intubation
1
2
3
4
5
6
7
8
9
10
11
12
Total
Leforte
number 1
X
X
X
X
X
X
6
Leforte
number 2
Leforte
number 3
X
X
X
X
X
X
X
X
X
X
X
9
NOE
number
Mandible
number
Duration of the
procedure (min)
X
X
X
7
7
10
5
6
8
7
5
9
7
10
7
7.3
X
X
X
X
X
X
X
X
X
X
X
X
X
X
8
None
None
None
None
Abscess at floor of mouth
None
None
None
None
None
None
None
b
Figure 1: (a) Flexometallic endotracheal tube, (b) Endotracheal tube with
detached universal connector
Results
All patients underwent a successful transmylohyoid
oroendotracheal intubation and all of them were
extubated immediately after completion of the surgical
procedure. There were no major intra operative or
postoperative complications related to this procedure.
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Khan, et al.: Transmylohyoid oroendotracheal intubation
Figure 3: (a) 3 D Recon image of Patient with bilateral leforte II, NOE complex
and mandibular fracture; (b) Transmylohyoid Oroendotracheal intubation
depicted clinically
Discussion
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Khan, et al.: Transmylohyoid oroendotracheal intubation
Conclusion
Transmylohyoid oroendotracheal intubation technique
is a fast, simple, effective and a very reliable alternative
to tracheotomy in managing complex craniomaxillofacial
surgeries where prolonged ventilatory support is not
required.
References
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